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04-DECEMBER-2008  NAHIDAH IBRAHEEM AL-DAHLAH  75 YEARS  LUMBAR CANAL STENOSIS L3-4 AND L4-5 WITH LEFT LATERAL RECESS SYNDROME AT L5 ROOT.

Anamnesis:

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The patient was admitted to the Shmaisani hospital 03-December-2008 with clinical history of bilateral sciatica more the right for 2 months with LBP for more than 3 years.

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MRI of the lumbar spine performed 02-December-2008 showing severe lumbar canal stenosis at L3-4 and L4-5 with left lateral recess syndrome at L5 root exit.

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On examination: the patient  has drop left foot with weak planterflexion both feet 4/5 and dorsiflexion right foot 4/5. There is diabetic foot with neuropathic hypalgesia upon what, the left L5 territory had analgesia. The drop foot is for more than 2 months.

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Decompressive laminectomy of L3-4 and partial of L5 was performed. The epidural fat was missing at all levels. Foraminotomy of both L4 and L5 roots was performed. The left L5 root was exposed 10 mm below the point of compression and it was inspected and the small bony extrusion at this level from the L4-5 annulus fibrosis was inspected and it was decided not to violate the disc space. Routine closure of the wound.

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Smooth postoperative recovery and the power of the right foot normalized and the planterflexion of the left foot. The dorsiflexion of the left foot remained the same.


Comments

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Recovery of the compressed root depends upon 2 major factors: 1. the degree of compression with the subsequent damage of the fibers before surgery, 2. the length of time of damage, before surgery.

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Lumbar canal stenosis is a progressive disease and the sooner the better to perform surgery before permanent dame take place to the compressed root.

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